Validating the computerized mental health intake screening system

A standardized system for screening federal offenders for psychological problems is required as part of a comprehensive strategy to provide mental health services for federally sentenced offenders. The Computerized Mental Health Intake Screening System (CoMHISS) is a set of self-report measures designed to identify offenders at intake who need such services. This research was undertaken to determine if CoMHISS is a valid system for identifying these offenders.

CoMHISS is comprised of the Brief Symptom Inventory (BSI), Depression Hopelessness and Suicide Scale (DHS) and Paulhus Deception Scale (PDS). These measures, along with the Jail Screening Assessment Tool, Cognistat, Adult ADHD Self-Report Scale, and Brief Jail Mental Health Screen, were administered to 500 male offenders at the Regional Reception Assessment Centre (RRAC) in Pacific region between October 2006 and September 2007. This sample represents 96% of incoming offenders at RRAC over a 12 month period. Case reports based on clinical interviews were coded to determine if recommendations for further mental health services were made. Results of CoMHISS were compared to the recommendations for further services from the files.

CoMHISS identified a case for mental health service when results produced a T-score of 65 or greater on the Global Symptom Inventory (GSI) or two or more of the nine symptom specific subscales of the BSI, DHS Depression or Hopelessness scores at or above the recommended cut-off scores, or endorsement of a current suicide ideation item on the DHS.

The 2 by 2 table below presents the proportion of the 500 offenders who were screened in by CoMHISS and were determined by mental health professionals to require follow up. The sensitivity of CoMHISS (correct identification by CoMHISS of cases requiring service) was 76% (139/182), and specificity (correct identification of cases not requiring service) was 65% (208/318). CoMHISS has a 53% Relative Improvement Over Chance (RIOC), performing 53% better than randomly screening in offenders.

The 9% of cases that required service, but were missed by CoMHISS (false negatives) are of particular concern. Examination determined that 35% of these cases had been assessed as having cognitive deficits.

The results presented above support the use of the CoMHISS to inform decisions on the early identification of offenders with psychological problems. The research has also identified potential areas for improvement to the process by including a measure of cognitive functioning.

Prepared by: Geoff Wilton